SRM Specialty Hospital
SRM University
Ramapuram – Chennai
Tamilnadu – India
Neonatal Resuscitation New Concept
STATISTICS
1.Asphyxia > 900000/- year W.H.O 2000-2003.
2.23% of Neonatal deaths are Asphyxia Lancet 2005
3.4 million Neonatal death – World wide.
4.Neonatal death 20% China – 2005 developed countries have protocols/programmes like CME.
5.CPincidence – 2 per 1000 population
6.Asphyxia – Mortality More than morbidity.
7.CP- Prevalance 4 per 1000 live births.
8.One – out of 4 ‘bad’ babies – CP
ASPHYXIA
1. What is Asphyxia literally?
2. Is it a misnomer here?
3. Is it a CNS depression due to
bio-chemical metabolic change?
4. Can we call all cyanosis as
asphyxia?
5. What is asphyxia Neonatorum?
Pertinent Questions-NRT
►What is it?
►Where is it done?
►How is it done?
►Who can do it?
►What are the required Equipments?
►What is Asphyxia Neonatorum?
►Is “Asphyxia” a right word here?
►What are the ill effects of failure of NR (Littles’ disease)
►Can we correct it to 100% if so how?
Good Old Dictum – ABC
What is A/B/C?
If no cry or respiration
a) Intubations by ET tube.
b) Oxygen by catheter / mask / hood
c) Ambu bag inflation / deflation.
d) Positive pressure ventilation.
e) Neonatal intensive care unit admission
Is it all necessary?
Does it yield the desired fruit?
If not why should we dothe same?
Why should not we change for better?
New Technique (Designed by author)
“Old Order changeth,
Yielding place to new”
PNEUMONICS : TTDS (Forget ABC)
•T : Thirupathi
•T : Thirumala
•D : Devasthanam
•S : Sanctorum
Further Expansion
T FOR TACTILE - EMBRACES
a. Tapping Baby’s back
b. Tapping Baby’s soles
c. Tapping Baby’s Toes
d. Squeezing Baby’s Ear Lobe with gauze
e. Pushing left index finger into baby’s left molar
f. Squeezing chest through Axillae
g. “Feel of Bite” Sense: Massester Muscle Tone.
T For Tracheal - Embraces
•NG Tube Stimulation through Nose / Mouth.
•NG Tube Stimulation at Tracheal opening.
•Tracheal Suction without ET Tube
•Aim 1. Stimulation by touch
2. Suction of Aspirated
Amniotic fluid, Meconium,
Vernix casseosa
D For Drugs - Embraces
Drug stimulation by following drugs.
a.Glucose 10 – 20 %
b.Soda Bicarb 7.5% 99%
c.Beclamathasone inhaler by Special tubing + Thoracic Squeezing in Rhythmic fashion – 0.75%
d.Adrenalin
e.Deriphylline
f.Dexamethasone – Inj – If necessary
TTDS – Success rate 100% - If
1.FH was present 5 minutes before delivery
2.No cord around the neck more than Twice.
3.No cardiac / Pulmonary / CNS / Tracheobronchial anatomical abnormality.
4.No Hiatus hernia.
5.No birth weight below 1200 gms
6.No RDS / Foetal aspiration syndrome / HMD.
7.No previous H/O foetal death
8.No Maternal diabetes / hypertension / drug withdrawal
9.No Spinal shock due to spinal anaestheria
10.No Apgar score at 0 in first 5 mts.
11.No “feel of bite” at any time during resuscitation .
12.No Placenta Previa
A. Resuscitation Team - Work Assignment
1. Baby receiving
2.Baby positioning – Neck rest – head down
3.Warmer light
4.Suction machine – On / off
5.Chest compression / Tactile Stimulation.
B. Time Keeper
1.Notes birth time
2.Announces every minute by counts.
3.Announces HR / RR - Every Minute
4.Pulse Oxymeter Reader every minute
5.Venesection instruments.
6.umbilical cathetrisation – IV drip.
C. Equipment Procurement
1.Soda Bicarb
2.25% Glucose
3.Deriphylline
4.Dexamethasone
5.Beclamethasone Inhaler
6.Laryngoscope
7.suction catheters / Sterile Hand gloves - Size
8.NG tube size 5,8
9.Butterfly needle – No. 24
10. 20 ml / 5ml syringe
11. Needle No. 26.
12. Vitamin K
13. Styptochrome
14. Calcium
15. Diazapam
16. Epsolin
D. Resuscitator / commander / Chief coordinator (Doctor)
Baby Crying Score (designed by author as per the cry duration in seconds / minutes)
n0 - No cry at Birth and at any time
n1- 3 Average cry (5-10 Sec after each stimulus)
n4- 6 Good cry (> than 15 sec after stimulus interruptedly for 2 hrs)
n7- 9 Very Good luxurious cry > 30 seconds after each stimulus for 6 hrs or more.
Score 5 & above – Excellent cry - brain blood vessels – open fully.
If no cry - asphyxia develops? (cyanosis)
Asphyxia – causes CP / MR / Low academic performances
Behaviour problem like ADHD
Trump card of Neonatal Resuscitation if there is substandard cry
§Tracheal Suction
§Thoracic Squeezing
§Correction of Hypoglycemia
§Correction of Acidosis
§If child cries immediately after NaHCo3 it means uncorrected metabolic acidosis - now corrected
Drug Dose
ØFirst Shot : NaHCo3 (5ml) + 10% Glucose (5 ml) intra umbilically
ØSecond shot : If there is no satisfactory cry repeat same after 5 minutes.
ØRepeat Every 5 minutes for 3-5 times according to necessity.
Aggressive Neonatal Resuscitation Indication
Born as if still birth.
Born with low Apgar Below 5 after 5 minutes
Obvious Cyanosis
No cry for 5 minutes after delivery.
Gross Hypotonicity generalized
HR < 60 / Minute
RR < 16 / Minute
Precious Child
Procedure
Continuous chest compression & Tracheal Suction
Beclamethosone inhalar through tube
NaHCo3 + 25% Glucose – Large dose
Umbilical Venous Cathetrization
Defibrillation – When all measures fail.
Author’s
►Professional Experience : 45 years
►Pure Pediatrics experience : 35 years
►100% success rate in NRT : 20 years
Thank You
SRM University
Ramapuram – Chennai
Tamilnadu – India
Neonatal Resuscitation New Concept
STATISTICS
1.Asphyxia > 900000/- year W.H.O 2000-2003.
2.23% of Neonatal deaths are Asphyxia Lancet 2005
3.4 million Neonatal death – World wide.
4.Neonatal death 20% China – 2005 developed countries have protocols/programmes like CME.
5.CPincidence – 2 per 1000 population
6.Asphyxia – Mortality More than morbidity.
7.CP- Prevalance 4 per 1000 live births.
8.One – out of 4 ‘bad’ babies – CP
ASPHYXIA
1. What is Asphyxia literally?
2. Is it a misnomer here?
3. Is it a CNS depression due to
bio-chemical metabolic change?
4. Can we call all cyanosis as
asphyxia?
5. What is asphyxia Neonatorum?
Pertinent Questions-NRT
►What is it?
►Where is it done?
►How is it done?
►Who can do it?
►What are the required Equipments?
►What is Asphyxia Neonatorum?
►Is “Asphyxia” a right word here?
►What are the ill effects of failure of NR (Littles’ disease)
►Can we correct it to 100% if so how?
Good Old Dictum – ABC
What is A/B/C?
If no cry or respiration
a) Intubations by ET tube.
b) Oxygen by catheter / mask / hood
c) Ambu bag inflation / deflation.
d) Positive pressure ventilation.
e) Neonatal intensive care unit admission
Is it all necessary?
Does it yield the desired fruit?
If not why should we dothe same?
Why should not we change for better?
New Technique (Designed by author)
“Old Order changeth,
Yielding place to new”
PNEUMONICS : TTDS (Forget ABC)
•T : Thirupathi
•T : Thirumala
•D : Devasthanam
•S : Sanctorum
Further Expansion
T FOR TACTILE - EMBRACES
a. Tapping Baby’s back
b. Tapping Baby’s soles
c. Tapping Baby’s Toes
d. Squeezing Baby’s Ear Lobe with gauze
e. Pushing left index finger into baby’s left molar
f. Squeezing chest through Axillae
g. “Feel of Bite” Sense: Massester Muscle Tone.
T For Tracheal - Embraces
•NG Tube Stimulation through Nose / Mouth.
•NG Tube Stimulation at Tracheal opening.
•Tracheal Suction without ET Tube
•Aim 1. Stimulation by touch
2. Suction of Aspirated
Amniotic fluid, Meconium,
Vernix casseosa
D For Drugs - Embraces
Drug stimulation by following drugs.
a.Glucose 10 – 20 %
b.Soda Bicarb 7.5% 99%
c.Beclamathasone inhaler by Special tubing + Thoracic Squeezing in Rhythmic fashion – 0.75%
d.Adrenalin
e.Deriphylline
f.Dexamethasone – Inj – If necessary
TTDS – Success rate 100% - If
1.FH was present 5 minutes before delivery
2.No cord around the neck more than Twice.
3.No cardiac / Pulmonary / CNS / Tracheobronchial anatomical abnormality.
4.No Hiatus hernia.
5.No birth weight below 1200 gms
6.No RDS / Foetal aspiration syndrome / HMD.
7.No previous H/O foetal death
8.No Maternal diabetes / hypertension / drug withdrawal
9.No Spinal shock due to spinal anaestheria
10.No Apgar score at 0 in first 5 mts.
11.No “feel of bite” at any time during resuscitation .
12.No Placenta Previa
A. Resuscitation Team - Work Assignment
1. Baby receiving
2.Baby positioning – Neck rest – head down
3.Warmer light
4.Suction machine – On / off
5.Chest compression / Tactile Stimulation.
B. Time Keeper
1.Notes birth time
2.Announces every minute by counts.
3.Announces HR / RR - Every Minute
4.Pulse Oxymeter Reader every minute
5.Venesection instruments.
6.umbilical cathetrisation – IV drip.
C. Equipment Procurement
1.Soda Bicarb
2.25% Glucose
3.Deriphylline
4.Dexamethasone
5.Beclamethasone Inhaler
6.Laryngoscope
7.suction catheters / Sterile Hand gloves - Size
8.NG tube size 5,8
9.Butterfly needle – No. 24
10. 20 ml / 5ml syringe
11. Needle No. 26.
12. Vitamin K
13. Styptochrome
14. Calcium
15. Diazapam
16. Epsolin
D. Resuscitator / commander / Chief coordinator (Doctor)
Baby Crying Score (designed by author as per the cry duration in seconds / minutes)
n0 - No cry at Birth and at any time
n1- 3 Average cry (5-10 Sec after each stimulus)
n4- 6 Good cry (> than 15 sec after stimulus interruptedly for 2 hrs)
n7- 9 Very Good luxurious cry > 30 seconds after each stimulus for 6 hrs or more.
Score 5 & above – Excellent cry - brain blood vessels – open fully.
If no cry - asphyxia develops? (cyanosis)
Asphyxia – causes CP / MR / Low academic performances
Behaviour problem like ADHD
Trump card of Neonatal Resuscitation if there is substandard cry
§Tracheal Suction
§Thoracic Squeezing
§Correction of Hypoglycemia
§Correction of Acidosis
§If child cries immediately after NaHCo3 it means uncorrected metabolic acidosis - now corrected
Drug Dose
ØFirst Shot : NaHCo3 (5ml) + 10% Glucose (5 ml) intra umbilically
ØSecond shot : If there is no satisfactory cry repeat same after 5 minutes.
ØRepeat Every 5 minutes for 3-5 times according to necessity.
Aggressive Neonatal Resuscitation Indication
Born as if still birth.
Born with low Apgar Below 5 after 5 minutes
Obvious Cyanosis
No cry for 5 minutes after delivery.
Gross Hypotonicity generalized
HR < 60 / Minute
RR < 16 / Minute
Precious Child
Procedure
Continuous chest compression & Tracheal Suction
Beclamethosone inhalar through tube
NaHCo3 + 25% Glucose – Large dose
Umbilical Venous Cathetrization
Defibrillation – When all measures fail.
Author’s
►Professional Experience : 45 years
►Pure Pediatrics experience : 35 years
►100% success rate in NRT : 20 years
Thank You
